Cardiovascular Risk in Psoriasis: Current State of the Art

Author(s): Giuseppe Dattilo*, Francesco Borgia, Claudio Guarneri, Matteo Casale, Roberto Bitto, Claudia Morabito, Salvatore Signorelli, Niki Katsiki, Serafinello P. Cannavò.

Journal Name: Current Vascular Pharmacology

Volume 17 , Issue 1 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Psoriasis (Pso) is a chronic inflammatory immune-mediated skin disease associated with several comorbidities. Despite the growing number of studies providing evidence for the link between Pso and Cardiovascular (CV) disorders, there are still many unsolved questions, dealing with the role of the skin disease as an independent risk factor for CV events, the influence of Pso severity and duration on CV damage, the presence of Psoriatic Arthritis (PsA) as a predictor of increased CV mortality and morbidity and the detection of reliable clinical, laboratory and/or instrumental parameters to stratify CV risk in psoriatic patients. Moreover, it remains to clarify if the early treatment of the dermatosis may lower CV risk. In this paper we will try to provide answers to these queries in the light of the updated data of the literature.

Keywords: Psoriasis, cardiovascular risk, risk factors, coronary artery disease, metabolic syndrome, myocardial infarction.

Pariser DM, Bagel J, Gelfand JM, et al. National psoriasis foundation clinical consensus on disease severity. Arch Dermatol 2007; 143: 239-.
World Health Organization Global report on psoriasis. Geneva: World Health Organization 2016.
Machado-Pinto J, Diniz MS, Bavoso NC. Psoriasis: New comorbidities. An Bras Dermatol 2016; 91: 8-14.
Puig-Sanz L. Psoriasis, a systemic disease? Actas Dermosifiliogr 2007; 98: 396-402.
Prodanovich S, Kirsner RS, Kravetz JD, et al. Association of psoriasis with coronary artery, cerebrovascular, and peripheral vascular diseases and mortality. Arch Dermatol 2009; 145: 700-3.
Boehncke WH, Schön MP. Psoriasis. Lancet 2015; 386: 983-94.
Butcher M, Galkina E. Current views on the functions of interleukin-17A-producing cells in atherosclerosis. Thromb Haemost 2011; 106: 787-95.
Shlyankevich J, Mehta NN, Krueger JG, et al. Accumulating evidence for the association and shared pathogenic mechanisms between psoriasis and cardiovascular-related comorbidities. Am J Med 2014; 127: 1148-53.
Boehncke WH, Boehncke S, Tobin AM, et al. The ‘psoriatic march’: A concept of how severe psoriasis may drive cardiovascular comorbidity. Exp Dermatol 2011; 20: 303-7.
Gelfand JM, Neimann AL, Shin DB, et al. Risk of myocardial infarction in patients with psoriasis. JAMA 2006; 296: 1735-41.
Dattilo G, Lamari A, Scarano M, et al. Coronary artery disease and psoriasis. Minerva Cardioangiol 2014; 62: 119-21.
Katsiki N, Anagnostis P, Athyros VG, et al. Psoriasis and vascular risk: An update. Curr Pharm Des 2014; 20: 6114-25.
Ahlehoff O, Gislason GH, Charlot M, et al. Psoriasis is associated with clinically significant cardiovascular risk: A Danish nationwide cohort study. J Intern Med 2011; 270: 147-57.
Ogdie A, Yu Y, Haynes K, et al. Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: A population-based cohort study. Ann Rheum Dis 2015; 74: 326-32.
National Cholesterol Education Program.Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 2001; 285: 2486-97.
Armstrong EJ, Harskamp CT, Armstrong AW. Psoriasis and major adverse cardiovascular events: A systematic review and meta-analysis of observational studies. J Am Heart Assoc 2013; 2: e000062.
Malik S, Wong ND, Franklin SS, et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation 2004; 110: 1245-50.
Katsiki N, Perez-Martinez P, Anagnostis P, et al. Is nonalcoholic fatty liver disease indeed the hepatic manifestation of metabolic syndrome? Curr Vasc Pharmacol 2018; 16(3): 219-27.
Katsiki N, Athyros VG, Karagiannis A, et al. Should we expand the concept of coronary heart disease equivalents? Curr Opin Cardiol 2014; 29: 389-95.
Katsiki N, Athyros VG, Karagiannis A, et al. Characteristics other than the diagnostic criteria associated with metabolic syndrome: An overview. Curr Vasc Pharmacol 2014; 12: 627-41.
Katsiki N, Mikhailidis DP, Mantzoros CS. Non-alcoholic fatty liver disease and dyslipidemia: An update. Metabolism 2016; 65: 1109-23.
Athyros VG, Tziomalos K, Katsiki N, et al. Cardiovascular risk across the histological spectrum and the clinical manifestations of non-alcoholic fatty liver disease: An update. World J Gastroenterol 2015; 21: 6820-34.
Athyros VG, Katsiki N, Karagiannis A. Nonalcoholic fatty liver disease and severity of cardiovascular disease manifestations. Angiology 2013; 64: 572-5.
Carrascosa JM, Bonanad C, Dauden E, Botella R, Olveira-Martín A. Psoriasis and nonalcoholic fatty liver disease. Actas Dermosifiliogr 2017; 108: 506-14.
Narayanasamy K, Sanmarkan AD, Rajendran K, et al. Relationship between psoriasis and non-alcoholic fatty liver disease. Prz Gastroenterol 2016; 11: 263-9.
Takeshita J, Grewal S, Langan SM, et al. Psoriasis and comorbid diseases: Epidemiology. J Am Acad Dermatol 2017; 76: 377-90.
Ganzetti G, Campanati A, Molinelli E, et al. Psoriasis, non-alcoholic fatty liver disease, and cardiovascular disease: Three different diseases on a unique background. World J Cardiol 2016; 8: 120-31.
Mantovani A, Gisondi P, Lonardo A, et al. Relationship between non-alcoholic fatty liver disease and psoriasis: A novel hepato-dermal axis? Int J Mol Sci 2016; 17: 217.
Miele L, Vallone S, Cefalo C, et al. Prevalence, characteristics and severity of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis. J Hepatol 2009; 51: 778-86.
Gisondi P, Targher G, Zoppini G, et al. Non-alcoholic fatty liver disease in patients with chronic plaque psoriasis. J Hepatol 2009; 51: 758-64.
Wenk KS, Arrington KC, Ehrlich A. Psoriasis and non-alcoholic fatty liver disease. J Eur Acad Dermatol Venereol 2011; 25: 383-91.
Samarasekera EJ, Neilson JM, Warren RB, et al. Incidence of cardiovascular disease in individuals with psoriasis: A systematic review and meta-analysis. J Invest Dermatol 2013; 133: 2340-6.
Xu T, Zhang YH. Association of psoriasis with stroke and myocardial infarction: Meta-analysis of cohort studies. Br J Dermatol 2012; 167: 1345-50.
Horreau C, Pouplard C, Brenaut E, et al. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: A systematic literature review. J Eur Acad Dermatol Venereol 2013; 27(Suppl. 3): 12-29.
Brauchli YB, Jick SS, Miret M, et al. Psoriasis and risk of incident myocardial infarction, stroke or transient ischaemic attack: An inception cohort study with a nested case-control analysis. Br J Dermatol 2009; 160: 1048-56.
Egeberg A, Thyssen JP, Jensen P, et al. Risk of myocardial infarction in patients with psoriasis and psoriatic arthritis: A nationwide cohort study. Acta Derm Venereol 2017; 97: 819-24.
Ahlehoff O, Gislason GH, Lindhardsen J, et al. Prognosis following first-time myocardial infarction in patients with psoriasis: A Danish nationwide cohort study. J Intern Med 2011; 270: 237-44.
Armstrong AW, Harskamp CT, Ledo L, et al. Coronary artery disease in patients with psoriasis referred for coronary angiography. Am J Cardiol 2012; 109: 976-80.
Picard D, Bénichou J, Sin C, et al. Increased prevalence of psoriasis in patients with coronary artery disease: Results from a case-control study. Br J Dermatol 2014; 171: 580-7.
Engelmann MD, Svendsen JH. Inflammation in the genesis and perpetuation of atrial fibrillation. Eur Heart J 2005; 26: 2083-92.
Ungprasert P, Srivali N, Kittanamongkolchai W. Psoriasis and risk of incident atrial fibrillation: A systematic review and meta-analysis. Indian J Dermatol Venereol Leprol 2016; 82: 489-97.
Simsek H, Sahin M, Akyol A, et al. Increased risk of atrial and ventricular arrhythmia in long-lasting psoriasis patients. Scientific World J 2013; 201: 901215.
Eliakim-Raz N, Shuvy M, Lotan C, et al. Psoriasis and dilated cardiomyopathy: Coincidence or associated diseases? Cardiology 2008; 111: 202-6.
Hashim T, Ahmad A, Chaudry A, et al. Psoriasis and cardiomyopathy: A review of the literature. South Med J 2017; 110: 97-100.
Abuabara K, Azfar RS, Shin DB, et al. Cause-specific mortality in patients with severe psoriasis: A population-based cohort study in the UK. Br J Dermatol 2010; 163: 586-92.
Mehta NN, Azfar RS, Shin DB, et al. Patients with severe psoriasis are at increased risk of cardiovascular mortality: Cohort study using the general practice research database. Eur Heart J 2010; 31: 1000-6.
Dowlatshahi EA, Kavousi M, Nijsten T, et al. Psoriasis is not associated with atherosclerosis and incident cardiovascular events: The Rotterdam study. J Invest Dermatol 2013; 133: 2347-54.
Imbalzano E, Casale M, D’Angelo M, et al. Cardiovascular risk and psoriasis: A role in clinical cardiology? Angiology 2015; 66: 101-3.
Dattilo G, Imbalzano E, Casale M, et al. Psoriasis and cardiovascular risk: Correlation between psoriasis and cardiovascular functional indices. Angiology 2018; 69(1): 31-7.
Harrington CL, Dey AK, Yunus R, et al. Psoriasis as a human model of disease to study inflammatory atherogenesis. Am J Physiol Heart Circ Physiol 2017; 312: 867-73.
Torres T, Sales R, Vasconcelos C, et al. Framingham Risk Score underestimates cardiovascular disease risk in severe psoriatic patients: Implications in cardiovascular risk factors management and primary prevention of cardiovascular disease. J Dermatol 2013; 40: 923-6.
Li WQ, Han JL, Manson JE, et al. Psoriasis and risk of nonfatal cardiovascular disease in US women: A cohort study. Br J Dermatol 2012; 166: 811-8.
Henseler T, Christophers E. Psoriasis of early and late onset: Characterization of two types of psoriasis vulgaris. J Am Acad Dermatol 1985; 13: 450-6.
Bicer A, Acikel S, Kilic H, et al. Impaired aortic elasticity in patients with psoriasis. Acta Cardiol 2009; 64: 597-602.
Ulosoy RE, Karabudak O, Yokusoglu M, et al. Noninvasive assessment of impaired endothelial function in psoriasis. Rheumatol Int 2010; 30: 479-83.
Osto E, Piaserico S, Maddalozzo A, et al. Impaired flow reserve in young patients affected by severe psoriasis. Atherosclerosis 2012; 221: 113-7.
Polachek A, Touma Z, Anderson M, et al. Risk of cardiovascular morbidity in patients with psoriatic arthritis: A meta-analysis of observational studies. Arthritis Care Res (Hoboken) 2017; 69: 67-74.
Ernste FC, Sánchez-Menéndez M, Wilton KM, et al. Cardiovascular risk profile at the onset of psoriatic arthritis: A population-based cohort study. Arthritis Care Res (Hoboken) 2015; 67: 1015-21.
Shen J, Wong KT, Cheng IT, et al. Increased prevalence of coronary plaque in patients with psoriatic arthritis without prior diagnosis of coronary artery disease. Ann Rheum Dis 2017; 76: 1237-44.
Eder L, Jayakar J, Shanmugarajah S, et al. The burden of carotid artery plaques is higher in patients with psoriatic arthritis compared with those with psoriasis alone. Ann Rheum Dis 2013; 72: 715-20.
Dattilo G, Lamari A, Crosca S, et al. Correlation between insulin resistance and endothelial dysfunction assessed by flow-mediated dilation. Recenti Prog Med 2012; 103: 328-32.
Di Minno MN, Ambrosino P, Lupoli R, et al. Cardiovascular risk markers in patients with psoriatic arthritis: A meta-analysis of literature studies. Ann Med 2015; 47: 346-53.
Staniak HL, Bittencourt MS, de Souza Santos I, et al. Association between psoriasis and coronary calcium score. Atherosclerosis 2014; 237: 847-52.
Joshi AA, Lerman JB, Aberra TM, et al. GlycA is a novel biomarker of inflammation and subclinical cardiovascular disease in psoriasis. Circ Res 2016; 119: 1242-53.
Salomon J, Matusiak Ł, Nowicka-Suszko D, Szepietowski JC. Chitinase-3-Like Protein 1 (YKL-40) is a new biomarker of inflammation in psoriasis. Mediators Inflamm 2017; 2017: 9538451.
Erfan G, Guzel S, Alpsoy S, et al. Serum YKL-40: A potential biomarker for psoriasis or endothelial dysfunction in psoriasis? Mol Cell Biochem 2015; 400: 207-12.
Ahmed SF, Attia EA, Saad AA, et al. Serum YKL-40 in psoriasis with and without arthritis; correlation with disease activity and high-resolution power Doppler ultrasonographic joint findings. J Eur Acad Dermatol Venereol 2015; 29: 682-8.
Giannoni M, Consales V, Campanati A, et al. Homocysteine plasma levels in psoriasis patients: Our experience and review of the literature. J Eur Acad Dermatol Venereol 2015; 29: 1781-5.
Balta I, Balta S, Demirkol S, et al. Elevated serum levels of endocan in patients with psoriasis vulgaris: Correlations with cardiovascular risk and activity of disease. Br J Dermatol 2013; 169: 1066-70.
Balta S, Mikhailidis DP, Demirkol S, et al. Endocan: A novel inflammatory indicator in cardiovascular disease? Atherosclerosis 2015; 243: 339-43.
Balta S, Mikhailidis DP, Demirkol S, et al. Endocan and atherosclerosis. Angiology 2015; 66: 490.
Wang X, Zhang G, Jiang X, et al. Neutrophil to lymphocyte ratio in relation to risk of all-cause mortality among patients undergoing angiography or cardiac revascularization: A meta-analysis of observational studies. Atherosclerosis 2014; 234: 206-13.
Minakawa S, Kaneko T, Matsuzaki Y, et al. Psoriasis area and severity index is closely related to serum c-reactive protein level and neutrophil to lymphocyte ratio in Japanese patients. J Dermatol 2017; 44(10): 236-7.
Chu SG, Becker RC, Berger PB, et al. Mean platelet volume as a predictor of cardiovascular risk: A systematic review and meta-analysis. J Thromb Haemost 2010; 8: 148-56.
Saleh HM, Attia EA, Onsy AM, et al. Platelet activation: A link between psoriasis per se and subclinical atherosclerosis–a case-control study. Br J Dermatol 2013; 169: 68-75.
Asahina A, Kubo N, Umezawa Y, et al. Neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and mean platelet volume in Japanese patients with psoriasis and psoriatic arthritis: Response to therapy with biologics. J Dermatol 2017; 44(10): 1112-21.
Evrengul H, Dursunoglu D, Kaftan A, et al. Bilateral diagonal earlobe crease and coronary artery disease: A significant association. Dermatology 2004; 209: 271-5.
Honma M, Shibuya T, Iwasaki T, et al. Prevalence of coronary artery calcification in Japanese patients with psoriasis: A close correlation with bilateral diagonal earlobe creases. J Dermatol 2017; 44(10): 1122-8.
Imbalzano E, Saitta A, Lamari A, et al. Echo-doppler evaluation of recent onset chronic venous insufficiency in elderly patients: Does the heart have a role? Recenti Prog Med 2013; 104: 569-73.
Imbalzano E, Di Bella G, Lamari A, et al. Right ventricular myocardial deformation in young healthy subjects: A comparison study between 2D Strain and traditional parameters. Exp Clin Cardiol 2014; 20: 2729-43.
Dattilo G, Imbalzano E, Lamari A, et al. Ischemic heart disease and early diagnosis. Study on the predictive value of 2D strain. Int J Cardiol 2016; 215: 150-6.
Katsiki N, Mikhailidis DP. Epicardial fat: A novel marker of subclinical atherosclerosis in clinical practice? Anatol J Cardiol 2017; 17: 64-5.
Katsiki N, Athyros VG, Mikhailidis DP. Abnormal peri-organ or intra-organ fat (APIFAT) deposition: An underestimated predictor of vascular risk? Curr Vasc Pharmacol 2016; 14: 432-41.
Katsiki N, Mikhailidis DP, Wierzbicki AS. Epicardial fat and vascular risk: A narrative review. Curr Opin Cardiol 2013; 28: 458-63.
Bulbul Sen B, Atci N, Rifaioglu EN, et al. Increased epicardial fat tissue is a marker of subclinical atherosclerosis in patients with psoriasis. Br J Dermatol 2013; 169: 1081-6.
Torres T, Bettencourt N, Mendonça D, et al. Epicardial adipose tissue and coronary artery calcification in psoriasis patients. J Eur Acad Dermatol Venereol 2015; 29: 270-7.
Katsiki N, Mikhailidis DP. Hyperuricaemia in cardiovascular diseases: A passive or an active player? Med Princ Pract 2015; 24: 269-70.
Katsiki N, Doumas M, Athyros VG, et al. Hyperuricemia as a risk factor for cardiovascular disease. Expert Rev Cardiovasc Ther 2015; 13: 19-20.
Wu AH, Gladden JD, Ahmed M, Ahmed A, Filippatos G. Relation of serum uric acid to cardiovascular disease. Int J Cardiol 2016; 213: 4-7.
Katsiki N, Papanas N, Fonseca VA, et al. Uric acid and diabetes: Is there a link? Curr Pharm Des 2013; 19: 4930-7.
Katsiki N, Karagiannis A, Athyros VG, et al. Hyperuricaemia: More than just a cause of gout? J Cardiovasc Med (Hagerstown) 2013; 14: 397-402.
Papanas N, Demetriou M, Katsiki N, et al. Increased serum levels of uric acid are associated with sudomotor dysfunction in subjects with type 2 diabetes mellitus. Exp Diabetes Res 2011; 2011: 34605.
Katsiki N, Athyros VG, Karagiannis A, et al. Hyperuricaemia and non-alcoholic fatty liver disease (NAFLD): A relationship with implications for vascular risk? Curr Vasc Pharmacol 2011; 9: 698-705.
Papanas N, Katsiki N, Papatheodorou K, et al. Peripheral neuropathy is associated with increased serum levels of uric acid in type 2 diabetes mellitus. Angiology 2011; 62: 291-5.
Tsuruta N, Imafuku S, Narisawa Y. Hyperuricemia is an independent risk factor for psoriatic arthritis in psoriatic patients. J Dermatol 2017; 44(12): 1349-52.
Yilmaz E, Tamer E, Artüz F, et al. Evaluation of serum uric acid levels in psoriasis vulgaris. Turk J Med Sci 2017; 47: 531-4.
Solak B, Dikicier BS, Erdem T. Impact of elevated serum uric acid levels on systemic inflammation in patients with psoriasis. Angiology 2017; 68: 266-70.
Lai YC, Yew YW. Psoriasis and uric acid: A population-based cross-sectional study. Clin Exp Dermatol 2016; 41: 260-6.
Takeshita J, Wang S, Shin DB, et al. Comparative effectiveness of less commonly used systemic monotherapies and common combination therapies for moderate to severe psoriasis in the clinical setting. J Am Acad Dermatol 2014; 71: 1167-75.
Roubille C, Richer V, Starnino T, et al. The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: A systematic review and meta-analysis. Ann Rheum Dis 2015; 74: 480-9.
Merlo G, Cozzani E, Burlando M, et al. Effects of TNF-α inhibitors in patients with psoriasis and metabolic syndrome: A preliminary study. G Ital Dermatol Venereol 2017.
Ahlehoff O, Skov L, Gislason G, et al. Cardiovascular disease event rates in patients with severe psoriasis treated with systemic anti-inflammatory drugs: A Danish real-world cohort study. J Intern Med 2013; 273: 197-204.
Hugh J, Van Voorhees AS, Nijhawan RI, et al. From the medical board of the national psoriasis foundation: The risk of cardiovascular disease in individuals with psoriasis and the potential impact of current therapies. J Am Acad Dermatol 2014; 70: 168-77.
Katz HI, Waalen J, Leach EE. Acitretin in psoriasis: An overview of adverse effects. J Am Acad Dermatol 1999; 41(Suppl.): 7-12.
Robert N, Wong GW, Wright JM. Effect of cyclosporine on blood pressure. Cochrane Database Syst Rev 2010; CD007893.
Grace AA, Barradas MA, Mikhailidis DP, et al. Cyclosporine A enhances platelet aggregation. Kidney Int 1987; 32: 889-95.
Stiller MJ, Pak GH, Kenny C, et al. Elevation of fasting serum lipids in patients treated with low-dose cyclosporine for severe plaque-type psoriasis: An assessment of clinical significance when viewed as a risk factor for cardiovascular disease. J Am Acad Dermatol 1992; 27: 434-8.
Rungapiromnan W, Yiu ZZN, Warren RB, et al. Impact of biologic therapies on risk of major adverse cardiovascular events in patients with psoriasis: Systematic review and meta-analysis of randomised controlled trials. Br J Dermatol 2017; 176: 890-901.
Ahlehoff O, Skov L. Gislason, et al. Cardiovascular outcomes and systemic anti-inflammatory drugs in patients with severe psoriasis: 5-year follow-up of a Danish nationwide cohort. J Eur Acad Dermatol Venereol 2015; 29: 1128-34.
Wu JJ, Guérin A, Sundaram M, et al. Cardiovascular event risk assessment in psoriasis patients treated with tumor necrosis factor-α inhibitors versus methotrexate. J Am Acad Dermatol 2017; 76: 81-90.
Yang ZS, Lin NN, Li L, et al. The effect of TNF Inhibitors on cardiovascular events in psoriasis and psoriatic arthritis: An updated meta-analysis. Clin Rev Allergy Immunol 2016; 51: 240-7.
Wu S, Han J, Li WQ, Qureshi AA. Hypertension, antihypertensive medication use, and risk of psoriasis. JAMA Dermatol 2014; 150: 957-63.
O’Brien M, Koo J. The mechanism of lithium and beta-blocking agents in inducing and exacerbating psoriasis. J Drugs Dermatol 2006; 5: 426-32.
Ramessur R, Gill D. The effect of statins on severity of psoriasis: A systematic review. Indian J Dermatol Venereol Leprol 2017; 83: 154-61.
Naseri M, Hadipour A, Sepaskhah M, Namazi MR. The remarkable beneficial effect of adding oral simvastatin to topical betamethasone for treatment of psoriasis: A double-blind, randomized, placebo-controlled study. Niger J Med 2010; 19: 58-61.
Ports WC, Fayyad R, De Micco DA, et al. Effectiveness of lipid-lowering statin therapy in patients with and without psoriasis. Clin Drug Investig 2017; 37: 775-85.

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Page: [85 - 91]
Pages: 7
DOI: 10.2174/1570161115666171116163816
Price: $58

Article Metrics

PDF: 39
PRC: 1